Control of fever by continuous, low-dose diclofenac sodium infusion in acute cerebral damage patients

Objectives: The aim of this study was to assess the efficacy and safety of low doses of diclofenac sodium (DCF) in attaining normothermia with minimal major side effects in patients with acute cerebral damage. The study was designed to verify the adequate, prolonged antipyretic action of DCF infusion, to quantify its haemodynamic and cerebral impact and to assess any negative effect on renal and liver function. Design: Retrospective, cohort study on prospectively collected data. Setting: Intensive care unit (ICU) of a university hospital. Patient population: Five patients with subarachnoid haemorrhage and seven severe head-trauma victims with febrile illness of various infectious origin. Interventions: Continuous i.v. infusion of a low dose (0.04 mg/kg/h) of DCF for 48 h. Measurements and results: Systemic and cerebral haemodynamic data were collected at 4 h intervals for 8 h before diclofenac infusion and 48 h after. Renal and liver functions were monitored. Normothermia, defined as external temperature < 37.5 degrees Celsius (°C), was achieved in all cases. Intracranial pressure was significantly lowered and mean arterial pressure was unaffected, so cerebral perfusion pressure rose after DCF. Hepatic and renal function were not altered in the 48 h post DCF. Mean urinary output was preserved at high flow and was not influenced by DCF. Conclusions: Continuous infusion of low-dose DCF attained normothermia without any major cerebral or systemic side effects. Renal and liver functions were unaffected. Once normothermia was achieved, intracranial and cerebral perfusion pressure improved.